Addressing mental health issues key when treating obesity

TORONTO -- When Kevin Healey walked into his doctor's office five years ago, the minor injury he was seeking treatment for was the least of his physical ailments.

His weight had crept up from 200 to 240 pounds over the past few months, his cholesterol levels had soared into dangerous territory, and his blood pressure caused instant alarm when it clocked in at 240/180.

His moods were deteriorating as quickly as his body, with feelings of fatigue and hopelessness intensifying as the scale inched higher.

Doctors eager to bring his physical symptoms under control launched a trial-and-error process to find the right combination of medications, some of which only made his body feel worse while deepening his emotional gloom.

It was only when he received a diagnosis for a mental health condition and his treatment plan began addressing both his physical and emotional state that things began to improve.

"I recognized that something much more serious was going on, it was much more complex than I thought," Healey said in a telephone interview. "The medications I was taking were operating directly on my blood pressure, but there were other problems that were going on, and my brain was now affected. Having some kind of medication that addressed my brain function was helpful."

According to a growing number of medical researchers, addressing mental health when treating obesity and its related conditions is not just helpful but essential.

Obesity shares many of the same physical causes and long-term effects as mental illness, they argue, adding the two conditions often wind up dovetailing and exacerbating each other over time.

Dr. Arya Sharma, scientific director of the Canadian Obesity Network, said this critical relationship is often lost amid the usual messages most patients hear when seeking treatment for obesity or conditions associated with it.

"In assessing someone for obesity, you need to assess mental health as your number one priority before you even start thinking about what people eat and how much people move," he said. "Because right away you can assume that if there's a mental health problem going on, managing weight is going to be very difficult."

Sharma said people struggling with their weight often contend with mental stresses ranging from body image issues to serious mood disorders, all of which can hinder their efforts to shed extra pounds.

Mood has a direct impact on metabolism, he said, adding negative emotional turns can make it harder for the body to process certain foods.

A person struggling to adapt to a healthy lifestyle while also contending with depression or some other form of mental illness will find the combined weight of the conditions too challenging to manage, he said.

For those seeking treatment for mental illness, obesity poses a very real threat, he said. Many antipsychotic medications can cause weight gain, and food can present an easy and tempting alternative to coping strategies that haven't worked in the past.

Research suggests, however, that the links between obesity and mental health conditions are actually hardwired into human biology.

Dr. Roger McIntyre, head of the mood disorders unit at the University Health Network, said the correlation between the two states is too strong to be coincidental.

At least three quarters of the mood disorder patients he treats also struggle with their weight, he said, adding research indicates the same root cause may be responsible for both issues.

We already know that inflammation can cause depression. Activated immune systems can make you very, very depressed. What's more is if you have depression, your body is inflamed," he said. If someone is of normal body size and they develop a depression, the body goes into a state of inflammation, and that can produce obesity."

The same process can take place in reverse, he said, since excess weight can cause inflammation, which can then precipitate a decline in mental health.

Studies are currently under way to assess whether treating mood disorder patients with anti-inflammatory drugs such as Celebrex or Aspirin can have a positive impact on their weight struggles, McIntyre said, adding the results are still not known.

"We clearly need new treatments. And if it's the case that obesity and depression share some kind of causative factor, maybe that could shed some light on some exciting new directions for treatment," he said.

McIntyre and Sharma said health practitioners who are hoping to treat a patient with one condition should automatically keep an eye out for signs that the other is starting to become problematic. Many health care providers tend to take an overly simplistic approach to the complex ad overlapping issues, Sharma said, adding the growing rates of both obesity and mental illness are a testament to the fact that traditional messages don't work.

"They're saying 'it's all a matter of choice, and if I tell people what healthy eating is they'll just go out and do it,' not recognizing that (obesity) is as much a medical disorder and as much a medical condition as a lot of the mental health issues are," Sharma said.

Healey said his own experience supports the emerging body of research.

After several years of treatment for both his physical and mental symptoms, his blood pressure and cholesterol have returned to the higher end of the normal range while his weight has dropped more than 30 pounds.

A more holistic treatment plan, he said, gave him the renewed physical strength and mental clarity to make lifestyle changes that helped him regain control of his overall health.

"It's a bit like catching somebody before they fall all the way to the bottom," He said. "Medications won't cure you, but they can give you a step up so that you can start to figure things out and work out what it is you need to change."